BMC Pregnancy and Childbirth最新文献

Background: Hypertensive disorders during pregnancy (HDP) are a significant cause of maternal mortality. The present study examined the extent of preeclampsia and eclampsia guideline use across different healthcare provider groups, aiming to provide evidence-based recommendations for better guideline implementation.

Methods: A cross-sectional study was conducted from 2021-10-04 to 2022-04-04. Participants were maternal health providers from 63 medical universities in the country. For evaluating clinical applicability of the guideline, an online questionnaire developed. Questionnaire was designed to evaluate the Implementation, Usability, Validity, Applicability, Accommodation, and Evaluation of national guideline. The mean score for each question was calculated and categorized in unfavorable, relatively favorable, and favorable values. The online questionnaire was delivered to the all-guideline users. The answered questionnaires were sent back to the research team after a week.

Results: Totally, 1,283 health care providers as the respondents completed the questionnaires. The ways to access the guideline that were expressed by the participants were: printed book in 57.9%, medical websites in 11.2%, CDs in 10.5%, and posters, bulletins, and brochures in 20.4%. The results delineated that general practitioner had the highest scores related to the majority of domains consisting of Implementation, Usability, Evaluation, and Validity than Behvarz (community health workers in the rural and urban healthcare centers), midwife, and obstetrician groups (p < 0.01). The results showed that mother's non-compliance, non-practical content of guideline, and lack of facilities were the most important reported challenges in guideline implementation.

Conclusion: To effectively enhance the national preeclampsia guideline, it is critical to adopt a structured approach based on feedback from diverse healthcare providers. Key areas identified for improvement include ensuring comprehensive guideline awareness through better distribution, enhancing usability by simplifying language and offering quick-reference tools, regularly updating the guideline with new research, adapting it for varied clinical environments, accommodating the specific needs of different provider groups, and establishing a continuous evaluation mechanism through feedback loops. These steps aim to refine the guideline's practicality, reliability, and comprehensiveness in managing preeclampsia across diverse healthcare settings.

Background: Improving the quality of intrapartum and immediate postnatal care is critical for reducing maternal and neonatal mortality in low- and middle-income countries (LMICs). This review aimed to assess the extent of Person-Centred Maternity Care (PCMC) practices during childbirth in LMICs.

Methods: We retrieved studies from four databases, including PubMed/Medline, Embase, CINAHL, and Maternal and Infant Care, up to 30 May 2023 and updated 26 April 2024. Additionally, manual searching was performed to identify additional studies. Our study included studies that examined PCMC using PCMC scale. The included studies were assessed using the Joanna Briggs Institute (JBI) checklist for quality appraisal.

Findings: Twelve articles out of 888 were retained in the review. Among these, nine studies specifically examined various elements of PCMC, such as dignity and respect, communication and autonomy, and supportive care. The lowest and highest levels of the mean (± SD-standard deviation) PCMC were 46.5 (6.9) and 60.2 (12.3) out of 90 total scores in Ghana and urban Kenya, respectively. The lowest score was reported in the communication and autonomy subscale domain of PCMC at a mean (± SD) score of 8.3 (3.3). Women who were wealthier and educated, and those who received ANC and birthing care by the same health care providers were found to have a higher level of PCMC during childbirth. Whereas those women who did not have ANC follow-up, visited health facilities for ANC in the second or third trimester, stayed at health facilities after birth for 2-7 days, had complications, and received care from auxiliary midwives, nurses, or assisted by unskillled attendants were associated with a lower level of PCMC during childbirth.

Conclusions: Our findings indicated that the communication and autonomy components of PCMC are notably low, affecting the rapport between healthcare providers and women, as well as decision-making and the execution of procedures. To enhance PCMC, continuity of care through antenatal and intrapartum care provided by the same healthcare providers, along with fostering a supportive environment for both women and healthcare providers during childbirth is imperative.

Prospero id: CRD42023426638.

Background: The association between inflammatory indices from peripheral blood cell in early pregnancy and the risk of gestational diabetes mellitus (GDM) is unclear.

Methods: This was a retrospective study involving the medical data of 15,807 pregnant women who gave birth in 2019. Data were collected from the medical records and analyzed. The pregnant women's age, educational level, pre-pregnancy body weight, height, parity, family history of diabetes, lipid profile, blood pressure were recorded during 11 ~ 13^+ 6 pregnancy weeks. We collected and measured several easily accessible systemic inflammatory indices from peripheral blood cell count, including Neutrophils, Lymphocytes, Monocytes, MHR (monocyte count/HDL-C), SII (platelet count ×neutrophil count/lymphocyte count ) and SIRI (neutrophil count ×monocyte count/lymphocyte count), and we analyzed their association with the risk of developing GDM.

Results: In the present study, a total of 15,807 women were included, including 2,355 (14.9%) women diagnosed with GDM. Women who were diagnosed with GDM showed markedly lower level of monocyte count and higher level of neutrophil and lymphocyte counts. The GDM group showed relatively lower level of SIRI, while no significant differences were found between GDM group and non-GDM group in MHR or SII. After adjusting for potential confounding factors, we observed a significant association between monocyte counts, MHR and the risk of developing GDM, and the risk tended to decrease with increasing levels of monocyte counts and MHR.

Conclusion: The present study revealed that in early pregnancy, monocyte count and MHR have great potential as early diagnostic markers of GDM.

Background: Preterm birth (PTB) is the leading cause of infant mortality. Risk for PTB is influenced by multiple biological pathways, many of which are poorly understood. Some PTBs result from medically indicated labor following complications from hypertension and/or diabetes, while many others are spontaneous with unknown causes. Previously, investigation of potential risk factors has been limited by a lack of data on maternal medical history and the difficulty of classifying PTBs as indicated or spontaneous. Here, we leverage electronic health record (EHR) data (patient health information including demographics, diagnoses, and medications) and a supplemental curated pregnancy database to overcome these limitations. Novel associations may provide new insight into the pathophysiology of PTB as well as help identify individuals who would be at risk of PTB.

Methods: We quantified associations between maternal diagnoses and preterm birth both with and without controlling for maternal age and socioeconomic factors within a University of California, San Francisco (UCSF), EHR cohort with 10,643 births (n_term = 9692, n_{spontaneous_preterm} = 449, n_{indicated_preterm} = 418) and maternal pre-conception diagnoses derived from International Classification of Diseases (ICD) 9 and 10 codes.

Results: Thirty diagnoses significantly and robustly (False Discovery Rate (FDR) < 0.05) associated with indicated PTBs compared to term. We discovered known (hypertension, diabetes, and chronic kidney disease) and less established (blood, cardiac, gynecological, and liver diagnoses) associations. Essential hypertension had the most significant association with indicated PTB (adjusted p_BH = 4 × 10^-20, adjusted OR = 6 (95% CI 4-8)), and the odds ratios for the significant diagnoses ranged from 2 to 23. The results for indicated PTB largely recapitulated the diagnosis associations with all PTBs. However, no diagnosis significantly associated with spontaneous PTB.

Conclusions: Our study underscores the limitations of approaches that combine indicated and spontaneous births. When combined, significant associations were almost entirely driven by indicated PTBs, although the spontaneous and indicated groups were of a similar size. Investigating the spontaneous population has the potential to reveal new pathways and understanding of the heterogeneity of PTB.

Background: Venous thromboembolism is a leading cause of maternal death worldwide. The postpartum period is a time of particularly increased risk. International guidelines provide recommendations for when a woman should be offered thromboembolism prophylaxis, however they differ greatly in their criteria as to which women qualify for low molecular weight heparin (LMWH). The aim of this study was to determine the most common risk factors for women being recommended LMWH and compare the proportion of women who would qualify for postpartum LMWH according to four international guidelines.

Materials and methods: This cross-sectional study evaluated rates of postpartum LMWH prophylaxis by applying guideline recommendations from the American College of Chest Physicians (ACCP), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ). Demographic, medical and obstetric risk factors for venous thromboembolism were identified for individual women from one regional and two tertiary maternity hospitals in New South Wales, Australia between February and October 2022.

Results: A total of 338 women were included in the analyses. By applying RCOG guidelines, 53.6% of women would have qualified for postpartum LMWH compared with 40.2% of women using SOMANZ guidelines, 37.3% using SOGC guidelines, and 8.3% using ACCP guidelines. The most common risk factors were caesarean birth, maternal age greater than 35 years, body mass index above 30 kg/m² and instrumental birth.

Conclusions: There are considerable differences in the rates of women receiving postpartum pharmacological venous thromboembolism prophylaxis when recommendations from different international guidelines are applied. These differences reflect the wide variation in guideline recommendations for the use of LMWH following birth.

Background: There is a paucity of information concerning the short- and long-term benefits and harm of antenatal corticosteroid administration and of expanded corticosteroid administration with dexamethasone in the late preterm period. Thus, we aimed to compare the effect on short-term respiratory complications, hypoglycemia, and long-term neurodevelopmental disorders in neonates born in the late preterm period between cases with and without corticosteroid administration and evaluate the difference in effects according to the type of corticosteroid administered.

Methods: This retrospective observational cohort study included all women who had a singleton delivery in the late preterm period between January 2007 and December 2015. We extracted data from Korea National Health Insurance claims and National Health Screening Program for Infants and Children databases. Primary short-term outcomes were in the late preterm period. Concerning short-term effectiveness for respiratory morbidity, dexamethasone administration in the late preterm period was associated with respiratory complications and hypoglycemia in neonates. Long-term outcomes were neurodevelopmental disorders in infants/children observed at follow-up among all neonates until the end of 2018.

Results: Of 57,963 women who delivered late preterm births during the study period, 1,255 (2.2%) had received antenatal corticosteroid administration in late preterm period. Dexamethasone administration was associated with a decreased risk of transient tachypnea (adjusted odds ratio [aOR] 0.66, 95% confidence interval [CI] 0.50-0.88) compared with no antenatal corticosteroid administration, but this effect was not observed in relation to betamethasone administration (aOR 0.69, 95% CI 0.42-1.14).

Conclusions: Dexamethasone administration in late preterm infants was associated with a decreased risk of transient tachypnea compared with no corticosteroid administration but this effect was not observed with betamethasone administration. However, antenatal corticosteroid administration in the late preterm period did not lower the risk of other respiratory complications nor increase the risk of hypoglycemia, with no effect on neurodevelopment regardless of the type used.

Background: Mobile health (mHealth) technologies offer potential benefits for enhancing pregnancy care through timely information and personalized support. Yet, various barriers limit their adoption among pregnant women. This study explored the perspectives of Iranian pregnant women and healthcare stakeholders on the barriers and facilitators influencing mHealth utilization in pregnancy care.

Methods: A qualitative content analysis was conducted involving 21 participants including 14 pregnant women and seven healthcare stakeholders (including two obstetricians, two midwives, two medical informatics specialists, and one sociologist), who recruited via purposive sampling from hospitals affiliated with Mashhad University of Medical Sciences and private clinics in Northeast Iran from May to December 2023. Data were collected through semi-structured, in-depth interviews and analyzed using Hsieh and Shannon's (2005) conventional content analysis approach. Trustworthiness was ensured through triangulation, researcher's prolonged engagement, peer debriefing, member check, and audit trial.

Results: The main theme, "Barriers and facilitators for mhealth utilization in pregnancy care," encompassed four key categories including (1) Digital ecosystem challenges highlighting structural issues like inadequate infrastructure, economic constraints, cultural adaptation gaps, interface complexity, and data security concerns, (2) Healthcare system implementation barriers including integration issues, low digital literacy, and a lack of continuity with traditional healthcare practices, (3) User empowerment and engagement revealing that mHealth can enhance access to information, promote autonomy, and provide personalized support, and (4) Integration of mHealth in the Healthcare system demonstrating the transformative potential of mHealth for improving maternal health monitoring, communication, and evidence-based care strategies.

Conclusion: Addressing digital, financial, and cultural barriers while enhancing usability and user autonomy could significantly improve healthcare access and equity for pregnant women in Iran. Policymakers should prioritize scalable and culturally sensitive mHealth interventions to maximize these benefits across diverse communities.

Background: Pregnancy resulting from Medicalised Conception (MAC) is increasingly prevalent. In-Vitro Fertilisation (IVF) is the most common type of treatment which has been linked to increased pregnancy-specific anxiety and different approaches to parenting. This study explored the experiences of pregnancy and the transition to parenthood in individuals who conceived via IVF, identifying how they coped with any psychological difficulties.

Method: Participants who successfully achieved pregnancy via IVF and had given birth to an infant aged 12 weeks to two years old, were interviewed. Interviews were audio-recorded, transcribed and analysed using Interpretative Phenomenological Analysis.

Results: Based on data from 12 British participants, three superordinate themes were identified: (1) The lasting imprint of IVF: unidentified and unmet psychological needs. The resultant loss, grief and powerlessness associated with the IVF treatment left individuals emotionally vulnerable entering pregnancy. The lasting impact of IVF was evident, influencing birth preferences and feeding choices. (2) The fragility of pregnancy: helpless and existing in a world of uncertainty. Pregnancy was often approached with caution and trepidation, leading to methods of self-protection, such as difficulties in believing the existence of the pregnancy. (3) The parental function of healthcare systems: needing an anchor and a sense of safety highlighted the pivotal role of health systems and their ability to perpetuate or alleviate distress.

Conclusions: The psychological vulnerability of parents after IVF needs to be considered throughout the perinatal period. Monitoring of psychological well-being and the implementation of specialist services and peer support for individuals who conceive via IVF are recommended.

Background: Establishing an efficient multidisciplinary team for transferred postpartum haemorrhage (PPH) cases is challenging due to limited clinical exposure. We hypothesised that leveraging trauma team experience could effectively facilitate the development of such a team within a short timeframe.

Methods: In September 2019, a multidisciplinary team was established at our tertiary care centre to provide rapid management of critical PPH cases transferred from the obstetric clinic, prioritising immediate resuscitation and haemostatic interventions. This historical cohort study (2017-2022) compared outcomes before (2017-2018, before group [BG]) and after (2019-2022, after group [AG]) team establishment. Outcomes included process-related quality indicators, clinical measures such as length of hospital stay, intensive care unit (ICU) days, presence of the lethal triad, and hysterectomy rate.

Results: Of the 71 PPH patients transferred during the study period, 24 were in the BG and 47 in the AG. The AG demonstrated higher use of tranexamic acid (33.33% vs. 74.47%, P = 0.002), shorter time to the first blood transfusion (11 vs. 8 min, P = 0.029), and increased rates of arrival in the operating room within 60 min (25% vs. 80%, P = 0.014). Clinical outcomes showed reduced rates of cardiopulmonary resuscitation (16.67% vs. 0%, P = 0.011) and shorter ICU stays (4 vs. 1 day, P = 0.005) in the AG.

Conclusions: Leveraging trauma team expertise is an effective strategy for establishing a multidisciplinary PPH team, significantly improving outcomes for critically ill PPH patients transferred from obstetric clinics.